Middle Ear Testing With a Tympanometry

Tympanometry can be used to identify reasons for hearing loss such as fluid in the ears (acute otitis media) or otosclerosis. Hearing loss due to fluid in the ears is one of the most common problems for children and tympanometry can be used to add an objective (quantitative) analysis of the eardrum and middle ear.

Tymapnometry is performed by inserting a tool called a tympanometer into the ear canal. The tympanometer looks like an otoscope or similar to an ear thermometer, however, it delivers sound waves while a vacuum creates both positive and negative pressures within the ear canal. The returned energy creates a waveform that a physician can use to evaluate for disorders of the middle ear. The generated waveform is called a tympanogram, which can then be used by the physician to evaluate the functionality of the eardrum.

Ear exam
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Preparing for Tympanometry

Prior to tympanometry testing, your physician will visualize the ear canal to evaluate for obstruction such as from impacted earwax. Obstruction of the ear canal or other ear abnormalities may impact the results of the test. While observing the ear canal with an otoscope, your physician may use a pneumatic otoscope, which is an otoscope with a bulb attached that once squeezed allows your physician to look for movement of your eardrum with pressure.

Visual examination with an otoscope allows your physician to make a subjective and qualitative assessment based on what they see. No risks are associated with the use of an otoscope or tympanometer. Due to the use of pressure in the ear, mild discomfort may be felt during either test. Small children or those who are sensitive may also object to the feeling of having something inserted into the ear but in general, these exams are not considered to be painful.

During the Test

The actual tympanometry test does not take long and does not involve more than inserting the tympanometer into the ear canal for a very brief period of time. However, for the results to be accurate you should refrain from swallowing, talking or crying during the test as these activities can affect the pressure in the ear and skew the results.

Results of Tympanometry

Tympanometry generates a graph report called a tympanogram. The tympanogram will show 4 different types of results as follows:

  • Type A: Normal tympanogram
  • Type B: Abnormal tympanogram related to fluid in the ears or a hole in the eardrum
  • Type C: Abnormal tympanogram related to early/late-stage ear effusion or eustachian tube dysfunction (may be related to sinus disorders)
  • Type AS: Abnormal tympanogram related to sclerosis or otosclerosis
  • Type AD: Abnormal tympanogram related to dislocation of the bones of the middle ear


Research shows that both visual exams with a pneumatic otoscope and tympanometry can be used to clearly identify fluid in the ears. However, the pneumatic otoscope is both more accurate and provides a clearer diagnosis when performed by an experienced physician. Otolaryngologists will likely be more skilled with a visual examination than a family practitioner. However, any physician can use tympanometry to help with their diagnosis of your hearing loss.

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By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.